British Journal of Radiology 75 (2002),72-73 © 2002 The British Institute of Radiology
Orbital metastasis from gall bladder carcinoma
A Misra, MS
1
S Misra, MS, MCh, MAMS
2
A Chaturvedi, MS, MAMS
2 and
P K Srivastava, MD
3
Departments of 1Ophthalmology, 2Surgical Oncology and 3Radiotherapy, King George's Medical College, Lucknow U.P., India
Correspondence: Dr S Misra, 122 Faizabad Road, Near Indira Bridge, Lucknow 226007, U.P., India
 |
Abstract
|
|---|
Clinical presentation of an extraabdominal metastasis from carcinoma of the gall bladder is rare. Orbital metastasis from gall bladder carcinoma has not been previously reported. We report a case of a 40-year-old woman who developed orbital metastasis from carcinoma of the gall bladder.
|
Introduction
|
|---|
Gall bladder carcinoma is common in North India [1]. However, extraabdominal metastases from the disease are rare [1, 2]. An English language Medline search of January 1966 to August 2001 produced no reported cases of metastasis ofgall bladder carcinoma to the orbit. Here we describe a case of gall bladder carcinoma metastasizing to the orbit.
|
Case report
|
|---|
A 40-year old female was referred with histopathologically proven adenocarcinoma of the gall bladder discovered following cholecystectomy at a district hospital 1 month previously. At the time of presentation the patient had no clinical evidence of abdominal disease. A hard, left supraclavicular lymph node measuring 2 cm x 3 cm was palpable. Fine needle aspiration cytology (FNAC) of the node confirmed it to be metastatic adenocarcinoma. Abdominal ultrasound revealed no residual nodal or hepatic disease. The chest radiograph was normal. The patient was placed on combination chemotherapy of 5-fluorouracil and mitomycin C.
2 months later, while on treatment, she complained of pain in the left eye. An ophthalmic examination showed fullness over the superior and medial part of the left orbit as well as a left divergent squint. Diplopia was present both in adduction and abduction. Medial ocular movements were restricted. The fundus was normal. Ultrasound examination of the left eye revealed a 7 mm x 9 mm irregular, nodular, hypodense mass in the superior and medial part of the orbit. CT of the orbit confirmed the ultrasound findings and showed a nodular, enhancing lesion involving the left medial rectus muscle and extending laterally to displace and involve the optic nerve (Figure 1
). FNAC of the mass was performed, which disclosed malignant cells consistent with the diagnosis of adenocarcinoma. At this time the patient also developed clinical jaundice, confirmed by serum biochemistry. Repeat ultrasound of the abdomen showed a large subhepatic mass obstructing the common bile duct. Chemotherapy was discontinued and the patient was advised symptomatic and supportive care.
|
Discussion
|
|---|
Carcinoma of the gall bladder is one of the commonest malignancies in females in North India [1]. Metastases from gall bladder carcinoma commonly affect the liver and the paraaortic lymph nodes [1, 3]. Clinical presentation of gall bladder carcinoma with distant metastasis is rare [1, 2]. Rare sites of metastases include the skin [4], bone [5], the central nervous system [6] and the heart [7].
Orbital metastases from malignant neoplasms are rare and can originate from anywhere in the body [8]. In adults, the primary tumour is almost always a carcinoma, with breast and lung carcinoma accounting for the vast majority of orbital metastases [9], followed by genitourinary and gastrointestinal primaries [8–10]. We found no cases in the literature of metastasis to the orbit from carcinoma of the gall bladder. Metastatic disease at distant sites may reflect the aggressive nature of gall bladder carcinoma and may be associated with advanced locoregional disease and a poor prognosis.
Received for publication September 11, 2001.
Accepted for publication November 6, 2001.
|
References
|
|---|
-
Misra NC, Misra S, Chaturvedi A. Carcinoma of the gallbladder. In: Johnson CD, Taylor I, editors. Recent advances in surgery 20. London: Churchill Livingstone, 1997:69–87.
-
Koo J, Wong J, Cheng FCY, Ong GB. Carcinoma of the gallbladder. Br J Surg 1981;68:161–5.[Medline]
-
Fahim RB, McDonald JR, Richards JC, Ferris DO. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 1962;156:114–24.
-
Bardaji M, Roset F, Puig A, Badal J, Fernandez-Layos MJ. Cutaneous metastatic adenocarcinoma of gallbladder origin: report of a case and review ofthe literature. Hepatogastroenterology 1998;45:930–1.[Medline]
-
Misra S, Chaturvedi A, Misra NC. Carcinoma gallbladder presenting with skeletal metastases. Indian J Gastroenterol 1997;16:74.[Medline]
-
Kawamata T, Kawamura H, Kubo O, Sasahara A, Yamazato M, Hori T. Central nervous system metastasis from gallbladder carcinoma mimicking a meningioma. Case illustration. J Neurosurg 1999;6:1059.
-
Suganuma M, Marugami Y, Sakurai Y, Ochiai M, Hasegawa S, Imazu H, et al. Cardiac metastasis from squamous cell carcinoma of gallbladder. J Gastroenterol 1997;6:852–6.
-
Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophthalmol 1997;81:386–90.[Abstract/Free Full Text]
-
Shields CL, Shields JA, Peggs M. Tumors metastatic to the orbit. Ophthal Plast Reconstr Surg 1988;4:73–80.[Medline]
-
Freedsman MI, Folk JC. Metastatic tumors to the eye and orbit: patient survival and clinical characteristics. Arch Ophthalmol 1987;105:1215–9.[Abstract/Free Full Text]
Top
Abstract
Introduction
